Confirmatory factor analysis of the multidimensional scale of perceived social support in clinically distressed and student samples

Previous authors (e.g., B. R. Sarason, Shearin, Pierce, & Sarason, 1987) have found that perceived social support can affect the emotional well-being of an individual. Consequently, the effective assessment of social supports is a key issue in both research and clinical practice. The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) divides perceived social support into 3 distinct constructs-that derived from Family members, from Friends, and from Significant Others. This study is the first to assess the MSPSS using confirmatory factor analysis in both a college student (N = 549) and psychiatric outpatient (N = 156) sample. Based on several goodness-of-fit indicators, a 3-factor model for the MSPSS was supported in both samples, as was a single, higher order domain of Global social support. The perceived social support factors of Family and Friends consistently had the strongest associations with symptomatology. These results support the use of the MSPSS as a brief instrument for assessing the hierarchical structure of perceived social support in a variety of samples.     

Cohesion and adaptability among individuals under treatment for infertility

The objective of this study was to evaluate cohesion and adaptability as relationship patterns of individuals in the presence or absence of infertility. Infertile subjects (20 men and 26 women, age 29.9 yr., SD = 3.8), and 100 fertile individuals (52 men and 48 women, age 29.5 yr., SD = 3.6) were included in this cross-sectional study conducted in Brazil. Subjects were married for the first time and had no children. The pattern of relationship (cohesion and adaptability) was assessed on the Family Adaptability and Cohesion Evaluation Scale (FACES III). Subjects were also interviewed and the interviews tape-recorded and analyzed by independent and blinded senior psychiatrists. The concepts of cohesion and adaptability did not differentiate infertile couples from fertile ones. Further, the recorded interviews also resulted in heterogeneous. nonconcordant judgments. These results lead to two conclusions: that awareness of infertility is not present in the population studied or that it is present but the magnitude of its effect is quite small and that FACES III and the interview focus on adaptability and cohesion are not sensitive enough to measure the difficulties in these couples' relationships. This leads us to reflect on the type of psychiatric support available to infertile couples.     

A Novel Approach to the Assessment of Fidelity to a Cognitive Behavioral Therapy for PTSD Using Clinical Worksheets: A Proof of Concept With Cognitive Processing Therapy

Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs). The current study examined fidelity measurement for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) using clinical worksheets. External raters evaluated patient worksheets done as a part of treatment, both guided by the therapist and completed independently as homework. Results demonstrated that fidelity ratings from CPT session worksheets were feasible and efficient. Notably, they were strongly correlated with observer ratings of the fidelity of CPT strategies that were present on the worksheets. Agreement among ratings conducted by individuals with a range of experience with CPT was acceptable to high. There was not a main effect of therapist-guided, in-session worksheet ratings on PTSD symptom change. However, patient competence in completing worksheets independently was associated with greater PTSD symptom decline and in-session, therapist-guided worksheet completion was associated with larger symptom decreases among patients with high levels of competence. With further research and refinement, rating of worksheets may be an efficient way to examine therapist and patient skill in key CPT elements, and their interactions, compared to the gold standard of observer ratings of therapy video-recordings. Additional research is needed to determine if worksheets are an accurate and scalable alternative to gold standard observer ratings in settings in which time and resources are limited.     

Work–family conflicts,cognitive appraisal,and burnout: Testing the mediation effect with structural equation modelling

Work–family conflict constitutes an important source of occupational stress predicting teachers’ burnout, and cognitive variables have shown to be core structures in explaining human adaptation to stress. Nevertheless, the role of cognitive appraisal needs to be fully analysed to comprehend how it can mediate the relationship between stress and burnout. In order to understand the potential mediation of cognitive appraisal in the relationship between stress and burnout, we adopted conceptual models of stress that highlighted the value of cognitive appraisal on positive and negative reactions to work demands. Also, we analysed the potential moderation of sex and age in the relationship between work–family conflict, cognitive appraisal, and burnout due to inconsistent findings on how these personal variables can interfere on these relations. In this study, we used structural equation modelling (SEM) to test the mediating of cognitive appraisal in the relationship between work–family conflicts and burnout. A survey with measures of work–family conflicts, cognitive appraisal, and burnout was administered to the participants consisting of 438 Portuguese teachers from kindergarten through high school, aged between 28 and 67 years (M = 46.85; SD = 7.88), 304 of whom were females (69.41%). The results confirmed that cognitive appraisal partially mediated the relationship between work–family conflict and burnout. The mediation effect of cognitive appraisal on the relationship between work–family conflict and burnout was invariant regardless of teachers’ sex or age. In sum, cognitive appraisal should be considered in order to understand teachers’ adaptation to work.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

The Perception of Persons with Anorexia Nervosa on Quality of Life: an Initial Investigation

Anorexia nervosa (AN) is an illness with a large impact on an individual’s quality of life, affecting relationships with friends and family, social inclusion, employment, personal development, and physical health, among other domains. However, most QoL studies primarily focus on health-related QoL without paying attention to the psychosocial and subjective aspects of QoL. In this study, QoL in persons with AN is investigated from a broad perspective. More specifically, this study aims at (1) gaining insight into the personal meaning of QoL of persons recovering from AN, (2) specifying the indicators of the QoL model of Schalock (J Intellect Disabil Res 48(3):203–216, 2004) for persons with AN, and (3) exploring the relationship between a specific treatment program and the perception on QoL of persons with AN. Therefore, in-depth interviews were conducted with 17 persons recovering from AN, who are supported by Empathie, a therapeutic center in Flanders, using solution-focused therapy and client-centered therapy, combined with a systemic orientation. The participants spontaneously mentioned the following themes when asked which elements are important to have a good QoL: interpersonal relationships, personal development, being able to relax, self-determination, and having a healthy lifestyle. Each domain of the QoL model of Schalock was operationalized into specific indicators for persons with AN. These indicators can help service providers to tailor their support strategies to the needs of each patient. The participants reported that being in therapy had positively influenced the following domains: interpersonal relationships, emotional well-being, self-determination, and social inclusion.     

The role of the amygdala in facial emotional expression during a discrimination task

A total of 50 patients with temporal lobe epilepsy with unilateral resection of the hippocampus and the amygdala were studied: --27 with left lobectomy (LTL group) and 23 with right lobectomy (RTL group)--; and 28 healthy control participants (HC group). The task consisted of identifying the dissimilar photograph from a group of photographs of the same face. The difference could correspond to the identity of the model or the facial expression (happiness, anger, sadness and fear). The results showed that when the difference in the photograph resided in the identity of the model, the RTL group made more mistakes than the HC group. When the facial expression was the distinguishing feature, mean response latency was longer in the LTL group than in the HC group. Comparison of the emotions revealed that the greatest differences were obtained with the fear expression, in all three participant groups. The dissociation of neural circuits responsible for processing facial expressions is discussed and, especially, the role of the left amygdala to discriminate between facial expressions.